Elsevier

Preventive Medicine

Volume 16, Issue 1, January 1987, Pages 119-130
Preventive Medicine

Clinical perspectives
Promoting health and preventing disease in health care settings: An analysis of barriers

https://doi.org/10.1016/0091-7435(87)90011-9Get rights and content

Abstract

Changes in lifestyle that promote health-enhancing behaviors and inhibit health-compromising behaviors have been recommended by the U.S. Surgeon General as an integral component of our general strategy for improving the health of the nation. A variety of innovations including new knowledge, new products, and new services have been developed with this recommendation in mind, and a major objective of these efforts is to identify settings for the effective diffusion and adoption of these new approaches into population groups that can make use of them. Health care settings such as hospitals, clinics, community health centers, health maintenance organizations, and private physicians' offices offer unique possibilities in this regard. Though opportunities exist for promoting health and preventing disease in other settings like schools and worksites, the primary objectives of such organizations are unrelated to health. Despite the obvious potential, however, our health care system has, in general, retained as its primary emphasis the treatment of disease rather than the enhancement of health. This article reviews the opportunities for health promotion and disease prevention in health care settings and identifies a range of barriers to such efforts. These barriers are discussed within a framework that focuses on dissemination and implementation as critical steps in the knowledge transfer process. Strategies for overcoming these barriers are described within the context of general linkage theory.

References (49)

  • C.E. Basch et al.

    Diffusion systems for education and learning about health

    Fam. Commun. Health

    (1986)
  • R.A. Behrens et al.

    Hospitals focus on their communities in the 80's

  • R.L. Berg

    Educating the consumer: Patient education and preventive medicine

    Bull. N.Y. Acad. Med.

    (1981)
  • A. Blum

    Medical activism

  • J.L. Campbell et al.

    Physician involvement in health education: Needs, problems, solutions

    Maryland State Med. J.

    (1983)
  • Centers for Disease Control

    Implementing the 1990 prevention objectives: Summary of CDC's seminar

    Morbidity and Mortality Weekly Reports

    (1983)
  • G.H. DeFriese et al.

    The program implications of administrative relationships between local health departments and state and local government

    Amer. J. Public Health

    (1981)
  • L. Eisenberg

    The perils of prevention: A cautionary note

    New Engl. Med. J.

    (1977)
  • J.W. Farquhar et al.

    Community education for cardiovascular health

    Lancet

    (1977)
  • J.W. Farquhar et al.

    Health promotion in health care settings

  • E.J. Freireich

    Is cancer prevention better than cure?

    JAMA

    (1979)
  • P. Greenwald et al.

    The scientific approach to cancer control

    Ca: Cancer J. Clin.

    (1985)
  • A.M. Gugenheim et al.

    Statements about the health education roles and responsibilities of selected care providers

    (September 1981)
  • Cited by (114)

    • Improving Hepatocellular Carcinoma Screening: Applying Lessons From Colorectal Cancer Screening

      2013, Clinical Gastroenterology and Hepatology
      Citation Excerpt :

      Although CRC screening rates consistently have improved over this time period, there still are many missed opportunities for screening recommendations.35 Physicians have reported multiple barriers to implementing cancer screening guidelines including inadequate levels of knowledge, provider forgetfulness, time constraints in clinic, provider fatigue, lack of financial incentive, and competing health problems.36,37 Successful strategies to bypass or increase provider recommendations for CRC screening rates have included organized screening efforts, patient-directed prompts, provider-focused reminders, and systematic mass screening programs.38

    • Research to practice in addiction treatment: Key terms and a field-driven model of technology transfer

      2011, Journal of Substance Abuse Treatment
      Citation Excerpt :

      The new field of implementation science studies the effects of individual, organizational, and systemic characteristics on the process of implementation. This definition is similar to those used by Fixsen et al. (2005), Lomas (1993), Orlandi (1987), Rogers (2003), and the NIH (2010). Numerous models of the implementation process have been developed.

    View all citing articles on Scopus

    Supported in part by Grant CA38219 from the National Cancer Institute.

    View full text